ASSESSMENT OF UTILIZATION OF GONAD SHIELD DURING PELVIC RADIOGRAPHY IN GOVERNMENT OWNED HOSPITALS IN ENUGU URBAN

Gonad shield is one of the most important protective measures used during pelvic radiography to protect the gonad which is very sensitive to radiation. This study on assessment of utilization of gonad shield during pelvic radiography in government-owned hospitals in Enugu urban. The study is  aimed at investigating if there is inconsistency in the use of gonad shield; determining radiographers level of knowledge on the guidelines for use of gonad shield, ascertaining  whether other radiation protecting measures are used often than gonad shield. This research was  carried out between May and July 2012 in the UNTH, NOHE, ESUTH. A target population of 52 radiographers practicing in government-owned hospitals in Enugu urban were selected. Also, 100 patients were selected as the target population of the patient. Convenient random sampling method was employed in selecting the sample sizes. Data collected were presented descriptively with aid of tables and charts. The result revealed inconsistency in the use of gonad shield as a result of high percentage of unavailability of gonad shield in various hospitals studied. It also revealed that many of the radiographers have good knowledge on the use of gonad shield as recommended by ICRP. Although, most of them consider other radiation protection measures because of unavailability of gonad shield in various hospitals studied. The study recommended that radiation protection officers should ensure that these hospitals studied are properly equipped with appropriate sizes and shapes of gonad shield in order to protect the gonad from irradiation during pelvic radiography. 

Title Page ........................................................................................   i

Dedication.......................................................................................... ii

Approval Page....................................................................................iii   

Certification......................................................................................... iv   

Acknowledgement.................................................................................v

Table of Contents...................................................................................vi    

List of figures.......................................................................................... x

Abstract.................................................................................................... xi

CHAPTER ONE: INTRODUCTION

1.0 Background of Study.......................................................................................

1.1 Statement of the Problem................................................................................

1.2   Objective of the Study.....................................................................................

1.3   Significance of the Study..................................................................................

1.4   Scope of the Study...........................................................................................

1.5   Operational Definition of Terms........................................................................

CHAPTER TWO: LITERATURE REVIEW

2.1    The Use of Gonad Shielding in Diagnostic Radiographic Procedures...............

2.2    Guidelines for the Use of Gonad Shielding in Radiography............................

2.3 Main Factors Influencing the Use of Gonad Shields During X-Ray Examinations....................................

2.4 The Use of Gonad Shield Reduces Radiation Dose to the Patient.......................

2.5    Theoretical Background...............................................................................

2.5.1 Anatomy of the Pelvis................................................................................

2.5.2   Plain Film Radiography of the Pelvis...........................................................

2.5.3   Advantages of Gonad Shield ......................................................

2.5.4   Different Designs and Sizes of Gonad Shield................................................

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Research Design...........................................................................................

3.2 Target  Population........................................................................................

3.3 Sample Size and Sampling Technique.............................................................

3.4 Tool for Data Collection..................................................................................

3.6 Method of Data Analysis.................................................................................

CHAPTER FOUR: RESULTS

4.1 Data presentation...........................................................................................

CHAPTER FIVE: DISCUSSION, CONCLUSION and RECOMMENDATIONS

5.1 Discussion of the Findings.  ....................................................................................

5.1.1 Demographic Findings.............................................

5.1.2 Objective 1( If there is inconsistency in the use gonad shield).....................

5.1.3 Objective 2 (Level of knowledge of radiographers on use of gonad shield  according to its guidelines’)............................................................................

5.1.4 Objective 3 (Whether radiographers employ other radiation protection measures often than use of gonad shield)............................

5.2 Conclusion...................................................................................................

5.3 Recommendations.....................................................................................

5.4 Areas of Further Research............................................................................

5.5 Limitations of the Study..........................................................................

References..........................................................................................................

Appendix 1. .............................................................................................................. 

Appendix 2................................................................................................................

Table 1:  Distribution of sex and age of the respondents

Table 2:   The frequency and percentage of radiographers from various hospitals used for the study

Table 3:  Responses of respondents on availability of gonad shield

Table 4:  Responds of respondents on consistency of utilization of gonad shield

Table 5:  Distribution of levels of  respondent’s knowledge on 

    use of gonad shield according to its guidelines’

Table 6:   Distribution of use of gonad shield and other radiation protecting measures

Table 7:   Distribution of responds on availability of gonad shield with consistency of its utilization

Table 8: The Response of respondents from various hospitals on availability of   gonad shield 

Table 9: The Response of respondents from various hospitals on consistency of utilization of gonad shield

Table 10:  The Response of respondents from various hospitals on their knowledge on use of gonad shield guidelines

Table 11: The Response of respondents from various hospitals on necessary radiation protection considered during pelvic radiography

Table 12:  Responses from Patients Respondents from various Hospital

Table 13:  Responses from the Patient on Use of Gonad Shield

                                                                                                                             

Fig 2:  Anteroposterior (Ap) View of Pelvis

Fig 3:  A female pelvis and male pelvis

Fig 4:  Oblique Views of the Pelvis

Fig: 5   Flat Contact Gonad Shielding

Fig: 6   X-ray protective gonad and ovarian shield

Fig: 7   X-ray protective male gonad shield

Fig 8:   Shows Years of Experience of Radiographers

Fig: 9   Distribution of Patient Sex

Fig: 10 Distribution of Patient Age

Gonad shield is a specially designed contact or shadow shield used to protect the gonad area of a patient from the primary radiation beam during radiographic procedures. The use of gonad shielding has been advocated for patients undergoing pelvic radiography before and during the reproductive years including women less than 40 years of age and all males.1 In certain diagnostic X-ray procedures, the patient’s gonads receive radiation doses from primary or scattered radiation. Even though the doses often are small, it is important to keep the gonad doses to patients, at or below the reproductive age, as low as reasonably achievable due to the potential for hereditary damage on offspring.1 National 2,3 and international bodies 1,4 recommend the use of gonad shielding when applicable. The effectiveness of gonad shielding is dependent on the correct use of the shield 5,7. Furthermore, the use of a shield must not result in significant loss of diagnostic information. The primary duty of radiographers is to produce images of high diagnostic quality with the minimal amount of dose being given to each patient. This duty of care is primarily upheld by using the ‘As low as reasonably achievable’ (ALARA) principle, which incorporates the use of time, distance and shielding in order to minimise patient dose.

Along with this, there is a public perception of the hazards of radiation, fed largely by incidents such as Chernobyl and nuclear fallout. Many patients present with an inflated sense of risk asso¬ciated with X-ray and expect a radiographer to protect them from this perceived danger.7   This expected protection is almost always in terms of gonad lead shielding. The use of gonad shielding is recommended, with respect to gender, as appropriate, in plain film radiography of the abdomen, pelvis, and lower spine or proximal femoral, and is intended to shield the gonads from the primary radiation beam when it does not interfere with obtaining the required diagnostic information. This is consistent with the recommendations of ICRP Publication 341 which states that: ‘The gonads should be shielded when, of necessity, they are directly in the X-ray beam or within 5 cm of it, unless such shielding excludes or degrades important diagnostic information.’ The use of gonad shielding when the region being examined lies further than 5 cm from the gonads, for example the lower leg, serves no useful purpose in terms of radiation dose minimisation. The specific area gonad shielding covers is an area slightly larger than the region of the gonad. It may therefore be used without interfering with the objectives of the examination to protect the germinal tissue of patients from radiation exposures that may cause genetic mutations during many X-ray procedures in which the gonads lie within or are in close proximity to the X-ray field. Therefore, gonad shield should be provided when the following conditions exist: when the gonad lie within the primary X-ray field, or within close proximity (about 5 centimeters) despite proper beam limitation. Examinations during which this is likely to occur include those involving the pelvis, hip, and upper femur, abdominal, lumbar, and lumbosacral spine examinations, intravenous pyelograms, abdominal scout films for barium enemas and upper gastrointestinal (GI) series, and femoral angiograms. As a basis for judgment, the specific area gonad shield should provide attenuation of X-rays at least equivalent to that afforded by 0.25 millimeter of lead. The clinical objectives of the examination will not be compromised, although specific area gonad shield usually does not  obscure needed information except in a few cases such as oblique views of the hip, retrograde urethrograms and voiding cystourethrograms, visualization of the rectum and, occasionally, the pubic symphysis. The decision concerning the applicability of shielding for an individual patient is dependent upon consideration of the patient’s unique anthropometric characteristics and the diagnostic information needs of the examination. The implementation of this policy is the responsibility of the radiographers, thus, gonad shield shall be considered when  the patient has reasonable reproductive potential, when the gonads lie within or close to the direct X-ray beam. The radiographic field shall be restricted to the area of clinical interest by the use of proper collimation. Gonad shielding should be used only when the clinical objectives of the examination will not be compromised. Thus, gonad shielding can be used in the majority of radiographic examination without obscuring visualization of adjacent structures.8  The entrance surface dose for single exposure varies from 0.26 mGy to 2.89 mGy9 for pelvic examination depending upon the body size of the patient. The total amount of radiation absorbed increases markedly when multiple X-rays are done, it also rises sharply when computer tomography (CT) scans10 and fluoroscopic studies are undertaken in these patients, whether of the pelvis or other regions of the body.11 Accordingly, it has been proposed that gonad protection should be carried out during all radiographic examinations whenever possible.12 The aim of this study is to assess the guidelines regarding the use of gonad shield in reducing gonad dose for common diagnostic procedures.